A08169 Summary:

BILL NOA08169A
 
SAME ASSAME AS S07199-A
 
SPONSORCruz
 
COSPNSRAnderson, Solages, Jackson, Simon, Mamdani, Fernandez, Hevesi, Dinowitz, Seawright, Sayegh, Rivera JD, Williams, Joyner, Tapia, Burgos, Barnwell, Colton, Glick, Gonzalez-Rojas, Forrest, Ramos, Aubry, Rivera J, Carroll, Burdick, Bichotte Hermelyn, Epstein, Gallagher, Jacobson, Septimo, De Los Santos, Kim, Jean-Pierre, Dickens, Niou, Rosenthal L, Griffin
 
MLTSPNSR
 
Amd §3217-b, Ins L
 
Prohibits certain provisions in health plan contracts including most-favored-nation provisions and restrictions on disclosure of actual claim costs, prices or quality in certain situations.
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A08169 Actions:

BILL NOA08169A
 
07/07/2021referred to insurance
01/05/2022referred to insurance
05/26/2022amend (t) and recommit to insurance
05/26/2022print number 8169a
05/27/2022reference changed to ways and means
05/31/2022reported referred to rules
06/01/2022reported
06/01/2022rules report cal.544
06/01/2022substituted by s7199a
 S07199 AMEND=A GOUNARDES
 06/07/2021REFERRED TO RULES
 01/05/2022REFERRED TO INSURANCE
 05/25/2022AMEND (T) AND RECOMMIT TO INSURANCE
 05/25/2022PRINT NUMBER 7199A
 05/31/2022COMMITTEE DISCHARGED AND COMMITTED TO RULES
 05/31/2022ORDERED TO THIRD READING CAL.1649
 06/01/2022PASSED SENATE
 06/01/2022DELIVERED TO ASSEMBLY
 06/01/2022referred to ways and means
 06/01/2022substituted for a8169a
 06/01/2022ordered to third reading rules cal.544
 06/03/2022passed assembly
 06/03/2022returned to senate
 12/02/2022DELIVERED TO GOVERNOR
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A08169 Committee Votes:

WAYS AND MEANS Chair:Weinstein DATE:05/31/2022AYE/NAY:29/5 Action: Favorable refer to committee Rules
WeinsteinAyeRaNay
GlickAyeFitzpatrickNay
NolanAyeHawleyAye
PretlowAyeMontesanoNay
ColtonAyeBlankenbushAye
CookAyeNorrisNay
CahillAyeBrabenecAye
AubryAyePalmesanoAye
CusickExcusedByrneNay
BenedettoAyeAshbyAye
WeprinAye
RamosAye
BraunsteinAye
McDonaldAye
RozicAye
DinowitzAye
JoynerAye
MagnarelliAye
ZebrowskiAye
BronsonAye
DilanAye
SeawrightAye
HyndmanAye
WalkerAye
BichotteAye

RULES Chair:Gottfried DATE:06/01/2022AYE/NAY:27/1 Action: Favorable
HeastieExcusedBarclayAye
GottfriedAyeHawleyAye
NolanAyeGiglioAye
WeinsteinAyeBlankenbushExcused
PretlowAyeNorrisAye
CookAyeMontesanoNay
GlickAyeRaAye
AubryAyeBrabenecAye
EnglebrightAye
DinowitzAye
ColtonAye
MagnarelliAye
PaulinAye
Peoples-StokesAye
BenedettoAye
LavineAye
LupardoAye
ZebrowskiAye
ThieleAye
BraunsteinAye
DickensAye
DavilaExcused
HyndmanAye

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A08169 Floor Votes:

There are no votes for this bill in this legislative session.
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A08169 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A8169A
 
SPONSOR: Cruz
  TITLE OF BILL: An act to amend the insurance law, in relation to certain prohibited contract provisions   PURPOSE OR GENERAL IDEA OF BILL: This bill, known as the Hospital Equity and Affordability Legislation (HEAL Act), aims to improve market access and increase transparency of health insurance contracts by banning certain anti-competitive provisions   SUMMARY OF PROVISIONS: Section one of the bill amends section 3217-b of the Insurance Law to prohibit insurers from entering into contracts with certain anti-compet- itive clauses such as most-favored-nation provisions. The bill would also allow insurers to disclose price and quality information regarding negotiated rates and other discounts with health care providers. Section two sets the effective date.   JUSTIFICATION: In recent years, hospital consolidation has resulted in dominant systems exercising anti-competitive market power. There have been a number of hospital mergers and acquisitions, with big hospitals acquiring smaller ones, along with physician practices. These hospital systems reduce competition and have the market power to dictate price. While these systems assert that the mergers will improve quality and reduce costs, the data does not support that. Instead they leverage their market power to increase prices when they negotiate rates and contracts with payers. And often these contracts include clauses that prohibit the disclosure of prices. The landscape, however, is changing. In California, a group of payers sued Sutter Health in a case that was joined by the State Attorney General. They argued that Sutter engaged in anticompetitive practices that drove up healthcare prices in Northern California. In March 2021, a Superior Court of California judge granted preliminary approval for a $575 million settlement, which also includes an agreement by Sutter Health to end "all or nothing" contract provisions requiring payers to contract with all Sutter hospitals if they wanted access to any Sutter facility. In New York, there are similar highly concentrated hospital markets. The recent public disputes between payers and the large systems have highlighted the need for increased transparency and visibility to the terms and conditions of such multi-year agreements and how such agree- ments are contributing to rising health care costs. Large hospital systems that maintain robust provider networks are leveraging that market share during negotiations to restrict health insurance networks designs and access. The result of these anti-competitive negotiation tactics is increased costs charged to insurance companies and self-in- sured entities, which ultimately are passed on to consumers, through premiums and cost sharing. Importantly, these agreements affect the networks for commercial lines of business including HMO, PPO, individual, small group, large group, self-insured benefit funds, the State of New York, the City of New York, other municipalities, Medicaid, and Medicare Advantage. This legis- lation aims to increase fairness and visibility by outlawing most favored nation clauses, which guarantee that a buyer of good or services (i.e. a payer) receives terms from a seller (i.e. a hospital or provid- er) that are at least as favorable as those provided to any other buyer. It would also bar anti-disclosure clauses, which are contractual provisions that prevent a party to the contract from revealing actual claims costs, negotiated rates or discounts, or patient cost-sharing data (protected health information would remain privileged and could not be disclosed). This bill would apply to all health plans negotiated by insurers, health maintenance organizations (HMOs), or third parties who administer a health plan on behalf of another entity such as a self-in- sured fund. In barring these two contract practices which are widely recognized to serve no purpose beyond the consolidation of market power and inflation of healthcare prices, this bill will increase transparency and ensure a fairer and more diverse healthcare marketplace for all.   PRIOR LEGISLATIVE HISTORY: None   FISCAL IMPLICATIONS: TBD   EFFECTIVE DATE: This act shall take effect on January 1st, 2023.
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A08169 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         8169--A
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                      July 7, 2021
                                       ___________
 
        Introduced by M. of A. CRUZ, ANDERSON, SOLAGES, JACKSON, SIMON, MAMDANI,
          FERNANDEZ,   HEVESI,   DINOWITZ,   SEAWRIGHT,   SAYEGH,  J. D. RIVERA,
          WILLIAMS, JOYNER, TAPIA, BURGOS, BARNWELL, COLTON, GLICK, GONZALEZ-RO-
          JAS,   FORREST,   RAMOS,   AUBRY,   J. RIVERA,    CARROLL,    BURDICK,
          BICHOTTE HERMELYN,     EPSTEIN,    GALLAGHER,    JACOBSON,    SEPTIMO,
          DE LOS SANTOS, KIM,  JEAN-PIERRE,  DICKENS,  NIOU  --  read  once  and
          referred to the Committee on Insurance -- recommitted to the Committee
          on  Insurance  in accordance with Assembly Rule 3, sec. 2 -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee
 
        AN ACT to amend the insurance law, in  relation  to  certain  prohibited
          contract provisions
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 3217-b of the insurance law is amended by adding  a
     2  new subsection (o) to read as follows:
     3    (o) (1) No contract or agreement between a health plan subject to this
     4  article  and  a  health care provider,   other than a residential health
     5  care facility as defined by section two thousand eight  hundred  one  of
     6  the public health law, shall include a provision that:
     7    (A) contains a most-favored-nation provision; or
     8    (B)  restricts  the ability of a health plan, an entity that contracts
     9  with a health plan for a provider network, or a health care provider  to
    10  disclose  (i)  actual  claims costs or (ii) price or quality information
    11  required to be  disclosed  under  federal  law,  including  the  allowed
    12  amount, negotiated rates or discounts, or any other claim-related finan-
    13  cial  obligations,  including,  but not limited to, patient cost-sharing
    14  covered by the provider contract to any insured, group or  other  entity
    15  receiving  health  care  services  pursuant  to  the contract, or to any
    16  public compilation of reimbursement data such as the New York all  payer
    17  database  required  by  law  or  regulation, provided that no disclosure
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11774-09-2

        A. 8169--A                          2
 
     1  shall include protected health information or other information  covered
     2  by statutory or other privilege.
     3    (2)  For  purposes  of  this  subsection, the term "health plan" shall
     4  include (A) an insurer licensed pursuant  to  the  insurance  law  or  a
     5  health maintenance organization certified pursuant to article forty-four
     6  of the public health law and (B) a third-party administrator, affiliated
     7  with  an  insurer  or health maintenance organization, who administers a
     8  health benefit plan.
     9    § 2. This act shall take effect January 1, 2023.
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